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Inspection on 21/04/06 for Deerwood Grange Nursing Home

Also see our care home review for Deerwood Grange Nursing Home for more information

This inspection was carried out on 21st April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The managers always ensure that a detailed initial assessment is completed prior to agreeing to the admission of any new residents. The staff actively encourage close relatives to maintain regular contact including where appropriate supporting residents with areas of care, such as with meals and with activities. The majority of care plans are well written, clear and concise, relatives are invited to help develop care plans to promote the choices and rights of residents. Relatives` comments included "this is the best home I have been to see", "I can visit at anytime", "my husband is always well turned out, he is clean and happy" and "meals are excellent".

What has improved since the last inspection?

Since the last inspection the home has been extended, including providing extra single bedrooms and reducing the amount of shared rooms. The extension has also provided additional toilets, bathing facilities and a new laundry. One relative commented, "The new room is really nice". Care plans of residents are regularly reviewed including how effective or not they have been, relatives commented that they are invited to help plan the care of residents and often make comment on what the residents needs are.The management and administration of residents` medicine is safe with regular audits completed to ensure safety is maintained. Fire safety including training and fire drills are regularly conducted and records of how effective the drills have been are maintained, with improvement plans made to further develop good practice. Staffing levels have been increased at night, one relative commented "it would be nice to have more staff when it is busy" and another said " it would be nice to have more staff, but there are no areas of neglect as no one is ever left".

What the care home could do better:

Written care plans and risk assessments must be written and implemented to support the changing needs of residents. Staff practices in moving and handling residents must be improved to ensure it is always safe. When delivering residents personal care this must always be completed in private. Food served and eaten by residents must always be hot, appetising, safe and of a texture that the residents can eat without difficulty. An option to the main meals must be available and included within the menu. Meal times need to be better organised including observing residents and effectively and sensitively supporting residents to eat. Infection control measures including hand washing facilities for domestics, odour management and the cleanliness of the kitchen must be improved. Evidence that staff are adequately supervised, trained and appropriately recruited must be available at the home. The registered manager must ensure that a quality system is introduced to review and improve the quality of care. This must include consulting residents and their representatives. An annual report on quality must be available in the home for residents, their representatives and the commission. There needs to be regular unannounced visits by the registered provider with reports available at the home.

CARE HOMES FOR OLDER PEOPLE Deerwood Grange Nursing Home 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD Lead Inspector Sean Devine Key Unannounced Inspection 21st April 2006 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Deerwood Grange Nursing Home Address 22 Wentworth Road Four Oaks Sutton Coldfield West Midlands B74 2SD 0121 355 0060 0121 355 0060 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BAMH (MIND) Ms Carol Mann Care Home 26 Category(ies) of Dementia (26), Mental disorder, excluding registration, with number learning disability or dementia (26) of places Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. That during the waking day there must be a minimum of 2 trained staff one of whom at times could be the manager plus 4 care staff. At night there must be a minimum of three waking staff one of whom is trained. 24th November 2005 Date of last inspection Brief Description of the Service: Deerwood Grange is a large adapted nursing home in the Four Oaks conservation area of Birmingham. The home is approached from a driveway, and is set back from the main road. To the rear of the building are large gardens, which are utilised by residents in good weather. The home has 18 single bedrooms and four double rooms (shared rooms). The building work to extend the home has now been completed. This has provided most residents with mainly single bedrooms and only a small increase in numbers accommodated. There are two large lounge areas, and a large dining room. The extension has provided a new laundry, a new disabled toilet and new down stairs shower room and the upstairs bathroom has been converted into a new shower room. There is a new staircase to access the first floor of the extension, access to the first floor using the passenger lift is via the original building. The home provides nursing care to residents over the age of sixty-five with a diagnosis of dementia and/or mental health issues. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken by one regulation inspector over a period of one day at the home. The inspector was able to meet many residents and their relatives. Staff were interviewed informally and formally. The inspector was able to case track three residents, meet with them and speak to staff and relatives about the residents care. Their care plans were inspected and so were other records regarding their health and welfare, for example, a check on the safety of their medication management by the nurses. A full tour of the premises was undertaken. What the service does well: What has improved since the last inspection? Since the last inspection the home has been extended, including providing extra single bedrooms and reducing the amount of shared rooms. The extension has also provided additional toilets, bathing facilities and a new laundry. One relative commented, “The new room is really nice”. Care plans of residents are regularly reviewed including how effective or not they have been, relatives commented that they are invited to help plan the care of residents and often make comment on what the residents needs are. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 6 The management and administration of residents’ medicine is safe with regular audits completed to ensure safety is maintained. Fire safety including training and fire drills are regularly conducted and records of how effective the drills have been are maintained, with improvement plans made to further develop good practice. Staffing levels have been increased at night, one relative commented “it would be nice to have more staff when it is busy” and another said “ it would be nice to have more staff, but there are no areas of neglect as no one is ever left”. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 5 and 6. The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the home. Residents’ needs are assessed and opportunities to visit the home are available to help residents and their representatives make a choice on whether they would like to live at the home. EVIDENCE: Three residents were case tracked and all their files were seen. Including the most recent resident admitted to the home. The home has a detailed statement of purpose available to all residents and their relatives, this includes a guide to the services, aims and objectives and resources available to meet the needs of residents. One of the three residents had a contract, one contract could not be found and the most recent admission had been admitted urgently and the contract is not yet available. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 9 The files all contained an initial assessment conducted either by the manager or deputy manager, these were all completed by visiting the resident, either in hospital or within a residential home. These assessments clearly identified, where information was available the immediate care needs of the residents. Other supporting information from social workers and through the nursing determination assessment process was available prior to admitting residents. Two relatives stated that they had been able to come and view the home and meet with staff and other residents before agreeing to the admission. One relative stated that she immediately had a good rapport with staff and that the home was just what was needed for her husband. The home does not provide an intermediate care service. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Residents are not fully supported to access required healthcare services and all their needs are not planned for, some staff practices are not safe and do not always promote the dignity of residents. Medication practices are good and promote the welfare and safety of residents. EVIDENCE: Two of the three residents had care plans. One resident was admitted the day prior to the visit and care plans were not available. One relative stated she was fully aware of the care plans and one said he did not wish to be involved with the care plans, however he was happy with the care given to his wife. Care plans for one resident following an operation and subsequent recovery period at the home, including wound care and mobility were not available. Daily records identified needs for this residents including pain from the wound site, no care plans for management were available. The available care plans for the two residents were generally well written, clear and concise, however one care plan for hygiene did not describe to staff what areas of support were Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 11 needed. Most care plans are reviewed on a monthly basis, detailed accounts of how effective or otherwise these plans have been are recorded. One care plan for wound management required a review after each change of dressing (every five days) evidence of these reviews were not available. The daily records did not generally reflect the care given to residents as prescribed by nurses in the care plans. Healthcare records were available to confirm that the residents were able to access their GP, S/W and Chiropodist. No information was recorded regarding access to a dentist or an optician. Two relatives stated that the home when needed had contacted them about the resident needing to see their GP. One relative said that dental care and glasses prescribed by an optician had been unsuccessful due to the advanced dementia of the resident, and that she had previously made the necessary appointments. Residents’ files did have risk assessments for tissue viability, moving and handling and behaviour. It was evident that for one resident her needs had changed and these risk assessments had not been reviewed. No residents had a detailed risk assessment available for nutrition or for falls. Two residents had either a dementia profile or a personal history, certain details within these documents indicated the need for a care plan or the involvement of other healthcare professionals. It was evident from these documents that one resident does not sleep well, there was no care plan or risk assessment available indicating how sleep deprivation was to be managed. Areas around communication, social and recreational activity, family and relationships and daily routines had been described in these documents and respective care plans had been written. One resident was assisted by two care staff to transfer from a wheelchair into an arm chair in the dining room, it was evident that the staff did not communicate effectively, which led to staff needing to be more forceful in positioning the resident prior to seating in the arm chair. No aids were used to assist the transfer. The wheelchair for one resident was pulled backwards into the dining area with no footplates on the wheelchair, causing the feet of the resident to drag along the floor. All residents’ files contained a recording on the tissue viability assessment of the monthly weights. All residents have their medicines managed by the home, records are generally well maintained, storage is safe and the deputy manager frequently conducts safety audits, which identifies areas for improvement and includes an action plan of how the improvement will be achieved. The managers and nurses were observed discussing the medication of the new resident, who had been prescribed large amounts of hypnotics and psychotropic drugs, they were concerned that these medicines had hindered the residents ability to be mentally and physically active and had planned to review all medicine with the GP as a matter of urgency. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 12 The majority of care seen was delivered in a dignified and respectful manner. Staff were observed addressing residents in a friendly and sensitive way and were also seen knocking on toilet doors to maintain privacy. One resident who was assisted to the dining area by staff had his dentures put in his mouth in front of other residents and visiting relatives. Relatives were pleased that staff are vigilant and ensure residents always look clean and well dressed, one relative said “they always wear their own clothes”. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents needs about autonomy are encouraged, their needs regarding social contact are met. Residents needs in respect of meal times, activities and how these daily life activities are supported are not met. EVIDENCE: Residents’ files included an assessment known as either a dementia profile or a personal history. These assessments included details of social and cultural needs, religious observations, recreation and pastimes. Care plans were available that described to staff how to meet these needs including activities that will support well being for residents such as crafts, exercises and entertainment. Staff were observed to spend time with residents either supporting them with needs or in general conversation. No planned activities were observed during the visit. One member of care staff who had worked in the home a short while stated that during the time at the home very few activities had been observed. The home does employ a part time activity coordinator. One resident was given the daily paper to read, he appeared to enjoy this and laugh at some of the news. Relatives commented that there were some activities, including parties and celebration days, such as a St Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 14 Georges Day lunch. One staff members’ opinion was that activities are available to residents, that this is assessed based upon their abilities, also that the home does encourage residents to be independent. One relative’s opinion was that there could be more music in the home, which her husband particularly enjoys. On the day of the visit many relatives were seen to visit the home, they were appropriately encouraged and supported by staff to assist residents with some of their needs, such eating at mealtimes. Relatives felt they are always welcomed at the home and that they can spend their visit time in private if they wish or in communal areas. One relative said “I can visit at any time, it is never a problem” and another said “I can visit ____ in his room and staff provide more seats, if there are more visitors”. One member of staff who was interviewed stated about the managers “ if residents do not wish to do something they do not have to do it” this was in regard to the managers approach to providing a care service. Relatives are made aware of care plans and risk assessments and decide upon whether they wish to be involved, this was confirmed by relatives. Relatives informed the inspector that they manage money on behalf of the residents and staff at times may prompt them if a resident is short of something. The lunch served in the dining room was sampled. An agency chef had cooked the meal. The fish coating (breadcrumbs) was found to be hard and difficult to eat. There was no visible menu, residents and some staff were unaware of what was for lunch. Some relatives put on blue aprons and went to feed their relatives (residents). The inspector was offered condiments, this was not seen to be extended to any residents. Some staff were unaware whether residents needed their meals cut up, this was seen when one staff member returned to a dining table and cut up the meal when it should have been cut up on the first occasion. Staff were observed (five in total) one serving and four delivering meals, as meals were given out no member of staff was observing tables, the inspector observed residents putting their hands in each others meals also some residents eating the food off each others plates. The lunchtime was not well organised, some residents had their meals fifteen minutes before others yet they were at the same table. The manager was observed assisting the new resident who was extremely sleepy and unaware of the meal, the manager was inventive and persistent to ensure the resident did eventually eat part of the meal. One resident was observed to have her meal, in front of her for ten minutes, staff eventually assisted, it was explained that she will sometimes feed herself however her meal may well have been cold. One resident was restless at lunch, she ate well but staff did observe that she needed the toilet, this was managed with some degree of dignity and this resident returned to eat her pudding. Staff were observed helping residents to eat their meals, the standard of this support was seen to differ depending on the staff member. Some staff were supportive and talked to the residents whilst others were seen to not talk and Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 15 tap the residents lip with a spoon or fork in order to prompt them to open their mouths. There are menus on the wall in the kitchen, that reflect a healthy and nutritional diet and also suggests that the cook will introduce foods from around the world, however the cook must ensure that alternative options are advertised in the menu. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has good policies and practices to ensure that complaints, concerns and protection issues are effectively and timely managed. EVIDENCE: Policies and procedures regarding the management of complaints and adult protection have previously been seen and assessed as good policies. There is no information to indicate that these have changed. Many residents indicated that they were happy, their non verbal communication was that of contentment. Staff who were interviewed raised no complaints, concerns or allegations. However one staff member shared her concern that although no resident had fallen on the main stairs she felt this was a risk. All staff were aware of their responsibilities under the Whistle blowing policy and most staff were aware of what they must do should any abuse be suspected. The complaints log has no recently recorded complaints. There has been no recent formal complaints to the home and no information of interest shared with the commission that may need investigating by the commission, provider or another agency. Sampled staff files indicate that staff are trained in POVA, not always immediately as part of induction but on a rolling training programme. Relatives did not have any cause for concern or complaint, they were clear of what they would do should they have any. One relative had a good knowledge Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 17 of the complaints policy and if concerned expressed that he would certainly use the formal process. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All standards were assessed. The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The overall requirement to provide safe, individual and a stimulating environment for residents is not met. EVIDENCE: A full tour of the premises was undertaken, including the new extension of the home. Communal areas: The manager confirmed that ramp is to be built to allow safe access to the large patio area of the garden. Bedding plants have been planted as a sensory garden which residents will be able to access later in the year. Some residents have plant pots in the garden. The garden wall has not been repaired, this was a requirement of the last inspection. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 19 Two lounges are well maintained, one is for residents who may smoke, both lounges are frequently used by residents, relatives and staff. The dining area is large, furniture, including table and chairs are ample, this area is used for activities with the co-ordinator. Residents rooms. There are eighteen single rooms and four shared rooms, with no en-suite facilities, all bedrooms have a wash hand basin. Rooms are clean and tidy, mostly hard floors, with electric adjustable beds with fitted rails. All rooms have a minimum of a single wardrobe, chest of drawers and bedside cabinet, new rooms have over bed light and ceiling light, older rooms have ceiling light and some have bedside lamps. Some rooms have one armchair, shared rooms are not large enough for two armchairs and many rooms have commodes. The manager has been required to audit the furniture and fittings in residents’ rooms to ensure that residents have all required furniture and fittings in their rooms or access to them. Many residents’ room doors have been damaged by wheelchairs and as previously required need repair and repainting. One room had a very strong odour. Relatives views on Communal areas and Residents rooms. Relatives are pleased with the standard of furniture and fittings in both areas, they believe residents have all they need. They are able to take visits in privacy should this be needed and they are happy with the décor. Laundry and kitchen areas. There are risk assessments in place to cover the kitchen HACCP (Hazard Analysis Critical Control Points) and the laundry area, COSHH risk assessments are available for products used in both areas, products are locked in sluice areas. It is a concern that in the downstairs sluice area cleaning staff cannot safely access the wash hand basin and thus do not use it. The laundry is new, with two commercial washing machines (with sluice cycles) and two large electric tumble dryers. The windows can be opened and an extraction fan is in operation. It is a concern that a 56kg bag of potatoes was on the floor outside the laundry door. The laundry has no iron in use due to staff safety issues, however the manager must ensure the clothing of residents is adequately laundered including ironing where needed. The kitchen area was in need of cleaning, the manager advised that the cook had been on holiday and they were using an agency cook to cover. The over cooker extraction filters were excessively greasy and the oven had old food items and required cleaning. The microwave was dirty and windows needed cleaning. The fly screen where broken must be repaired or replaced. There was a very good supply of all foods, fresh, refrigerated and frozen. Including fresh fruit and vegetables, it appears from the ingredients available that the permanent cook often does a lot of home cooking and baking, many relatives were complimentary about the standard and amount of food available Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 20 at the home. Records of the fridges and freezer temperatures are recorded, the digital temperature for one fridge has not been repaired as previously required and there are no records to suggest that the cook’s record the core food temperatures of all meats cooked at the home. Toilets and bathrooms. There are a range of toilets, bathrooms and shower rooms available and close by residents’ accommodation. These are clean and well equipped to meet the varied needs of residents; including a walk in shower, fully assisted seated bath and raised toilets, grab rails are available throughout. All toilets offer adequate privacy for residents. As good practice the manager must ensure that any showers that are not in use are regularly tested with water being “run off”. All toilets and bathrooms have adequate hand washing and drying facilities. Bathrooms, shower rooms and some toilets have clinical waste facilities. Environment for residents with a dementia. Staff who were interviewed demonstrated little knowledge of how the immediate environment impacts on the well / ill being of residents. Carpets are of many different colours, and signage especially on residents bedroom doors is not large enough or has not been developed to indicate to the resident it may be something they are interested in. Other than the main staircase, walk way areas appear safe with hand rails and residents are not restricted to corridors. There are very few areas of interest that will grab the attention of residents whilst they are walking in the home. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There are adequate numbers of staff in a variety of roles to meet the needs of residents. It is not evident that all staff are recruited in a manner that ensures the safety of residents and that they are adequately trained to meet the needs of residents. EVIDENCE: Since the inspection visit the manager has confirmed that twelve care assistants are employed of which ten have achieved NVQ 2 in Care or equivalent. There are two new care assistants who will commence training shortly as the organisations target is for new care assistants to achieve the award within eighteen months of commencing employment. Recruitment files were sampled, the inspector had previously seen most staff Criminal Records Bureau disclosures (CRB’s), however for the most recent recruit this was not available and had not been previously seen by the inspector. No application form, written references or induction training was available for this new recruit. The manager advised that documents were at MIND Head Office, and that she would ensure they were available at the next inspection. Staff rosters indicate staffing levels are maintained as five staff in the day, including four care assistants and a minimum of one trained nurse and at night Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 22 two care assistants and one trained nurse. There is also additional staff that work part time as domestics, laundry and in the kitchen. The cook is full time. The manager and deputy manager work in addition to the numbers, however at times due to vacancies, annual leave and sickness will work as the trained nurse with the care assistants. Staff in interview confirmed these staffing levels; one relative suggested that at busy times of the day there could be more staff on duty. Three staff were interviewed. Those interviewed explained that they did receive some training and had received a basic induction programme to the home. One care assistant explained about care plans and the role of keyworker, she was able recall the care needs of the residents she is a key-worker for. She said that all staff got on well together and that the agency staff were very good and that if staff have any concerns with agency workers they would point it out to them but if serious would report it to the managers. One staff member thought that agency staff should be trained by the agency in “common sense” things and understand procedures. She felt that staffing levels were okay. All staff files in respect of training are incomplete and cannot be adequately audited, it was evident from available information (certificates) that nurses are being trained, certificates for tissue viability, food hygiene, clinical supervision and for the storage and handling of medicines were available. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38. The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The residents are supported by a management team who are experienced within this field of care, knowledgeable and whose day to day operations of the home ensure their safety and welfare. The performance of the home is not audited and no quality reports are available to residents and their representatives. Staff are not adequately supported through the supervision process. EVIDENCE: The manager confirmed that she continues with her dementia training and that she receives regular clinical supervision. In the opinion of staff and relatives the manager is committed to her roles, she is knowledgeable and acts appropriately to ensure the home runs smoothly. They feel she is Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 24 approachable, that both the manager and deputy work in the best interests of residents and staff welfare. One nurse felt that both managers communicated well and that they gave nurses autonomy to get on with their jobs. Relatives declared that the managers were able to have some fun at work, and one relative said “I think they are brilliant”, another relative said “this is the best home I have been to see”. The manager advised that no formal audits against a set of quality standards had been undertaken, however audits of medication, accidents and staff training had commenced. There is no formal annual report available. The inspector is unaware of, and the manager did not indicate that unannounced visits by the registered provider are conducted, and the inspector has seen no reports of these visits. As previously reported upon the home does not manage any money for residents and does not keep any valuables in safekeeping, relatives confirmed that when a resident needs something such as toiletries or clothing the staff will either tell them or they know themselves as they frequently go into their relatives (residents) room. Staff confirmed that they were receiving regular supervision, either from the managers or from a nurse. The manager advised the inspector that the records of staff supervision have been fully completed but were not available in the home at present. It was evident from touring the premises that the environment is well maintained and safe. Records also indicate that the testing, servicing and maintenance of utilities and equipment is frequently undertaken and risk assessments for fire, food and the premises are available. Records indicate staff regularly attend fire drills and receive fire safety training. COSHH data sheets were sampled and found to be available for products being used in the home. As required at the last inspection a staff risk assessment detailing how safety is maintained in working with residents in shared rooms where there is limited space had not been completed. Relatives have no concerns about the safety of residents’ accommodation and in communal areas. The staff who were interviewed were unable to describe how the environment impacted upon the safety of residents, however a care assistant did have a concern about the easy access to the main stairs, which could be a problem. Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 2 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 2 X 2 Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5(1)(b,c) Requirement Timescale for action 31/07/06 2 OP7 15(1)(2) 12(1) The registered manager must ensure all residents are provided with a contract detailing the terms and conditions of residency. 31/05/06 The registered manager must ensure written care plans are available describing how the care needs of residents are to be met. The care plans must be clear and concise. These care plans must be reviewed to ensure the changing needs of residents are planned for. The registered manager must ensure that written risk assessments are available describing how the risks to residents are to be managed. These risk assessments must be reviewed routinely and following the changing needs of residents. Detailed risk assessments regarding the nutritional needs of residents and the risk of falls must be developed for all 3 OP8 15(1)(2) 12(1) 13(4) 31/05/06 Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 27 4 5 OP8 OP8 12(1) 17(2) 12(1)(a) 13(1)(b) residents. Daily records must be written that describe the care prescribed by nurses in the care plans. All residents must have their dental and optical care needs assessed and records must be maintained. Previous timescale of 31/5/05 not met, this requirement is carried forward. 31/05/06 30/06/06 6 OP8 18(1)(a,c) i 13(5) 7 OP8 12(4)(a) 8 OP12 15(1) 12(1) 9 OP15 16(2)(g, i) The registered manager must ensure that all staff are trained in safe moving and handling techniques and where needed use appropriate equipment. Staff practice in moving and handling residents must be safe. The registered manager must ensure personal care is delivered in a manner that promotes the privacy and dignity of residents. The registered manager must ensure that care plans regarding fulfilling activities, recreation and pastimes of residents are fully implemented and recorded. The core food temperatures of all cooked meats must be taken and recorded. The temperature gauge on one fridge must be repaired. Previous timescale of 31/01/06 not met, this requirement is carried forward. 31/05/06 31/05/06 31/05/06 30/06/06 10 OP15 16(2)(i) 13(4)(c) The registered manager must ensure that food served and eaten by residents is hot, appetising, safe and of a texture the residents can eat without difficulty. DS0000024837.V290666.R01.S.doc 31/05/06 Deerwood Grange Nursing Home Version 5.1 Page 28 11 OP15 16(2)(i) 12 OP15OP10 12(4)(a) 13 OP19 23(2)(b) The registered manager must ensure that the mealtime is observed by staff and any risks / concerns immediately managed. The registered manager must ensure that a menu with an alternative option is available for residents / relatives to choose the meal for the resident. The registered manager must ensure that all staff encourage and support residents to eat in a sensitive and respectful manner. The damaged paintwork on residents doors must be repaired. Previous timescale of 30/6/05 not met, these requirements are carried forward. 30/06/06 31/05/06 30/06/06 14 OP19 23(2)(b) The garden wall must be repaired. Previous timescale of 31/10/05 not met, this requirement is carried forward. 30/06/06 15 OP24 16(2)(c) The registered manager must audit the furniture and fittings in residents rooms, any gaps must be addressed or alternative provision made. This must be reflected in the homes statement of purpose. The manager must consult the residents and next of kin about the gaps and alternative provision. Previous timescale of 30/6/05 not met, these requirements are carried forward. 31/07/06 Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 29 16 OP26 13(3) The registered manager must ensure that cleaning staff have safe and ease of access to the hand washing facilities in the sluice rooms. 31/05/06 17 OP26 16(2)(k) 18 OP26 16(2)(e) 19 OP26 16(2)(j) The registered manager must ensure that the storage of food items is at all times safe and not in the vicinity of the laundry room. The registered manager must 31/05/06 ensure that any untoward odours are effectively managed and where possible eliminated. The registered manager must 31/05/06 ensure the clothing of residents is adequately laundered including ironing where needed. The registered manager must 31/05/06 ensure that the kitchen is kept clean, including extraction fan filters, oven, hob and microwave. 20 OP26 21 OP29 The kitchen windows must be kept clean and the broken fly screen repaired or replaced. 13(3) The registered manager must 31/05/06 ensure that any water outlets that are not in use are regularly “run off” and water temperatures recorded. 19(1)(a,b) The registered manager must 30/06/06 Sch 2. ensure that recruitment of staff is safe, that required checks POVA, CRB and two references are completed prior to employment and that an application form is appropriately completed. Evidence these have been completed must be available at the home. All staff must receive Infection Control training. DS0000024837.V290666.R01.S.doc 22 OP30 18(1)(c)i 31/07/06 Deerwood Grange Nursing Home Version 5.1 Page 30 Previous timescale of 30/9/05 not met, requirement is carried forward. Evidence that all staff have undertaken safe working practice training must be available at the home, these records must be rigorous and support the audit process. The manager must ensure that 30/09/06 regular consultation, which is recorded is undertaken, to elicit its performance against the statement of purpose, aims and objectives. This must include residents, their representatives and stakeholders. Previous timescale of 30/6/05 not met, this requirement is carried forward. An annual report on quality must be available in the home for residents, their representatives and the commission. The registered provider must ensure that regular monthly unannounced visits are undertaken and reports of visits are available at the home. This must include consultation with residents, relatives, staff and include an inspection of the premises. The registered manager must ensure that records of staff supervision are available in the home. A staff risk assessment must be completed to ensure the safety of residents and staff when working in confined spaces such as using hoists and wheelchairs in shared bedrooms. DS0000024837.V290666.R01.S.doc 23 OP33 24 24 OP33 26(1-5) 31/07/06 25 OP36 18(2) 30/06/06 26 OP38 13(4) 31/05/06 Deerwood Grange Nursing Home Version 5.1 Page 31 Previous timescale of 31/5/05 not met, this requirement is carried forward. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP15 OP15 OP19 Good Practice Recommendations The registered manager should consider ensuring that staff offer or know which condiments residents like on their meals. The registered manager should consider reviewing the mealtime process and ensure each table is served at the same time where this is possible. The registered manager should consider the impact the environment has on residents with a dementia and implement strategies to improve the environment, such as places of interest, good signage and the effects of colours in décor. The registered manager should consider detailing the risks and management plans of the open staircase within the premises risk assessment. 4 OP38 Deerwood Grange Nursing Home DS0000024837.V290666.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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